President Trump Takes Aim at Affordable Care Act; New York Governor Responds

Within hours of taking the Presidential oath of office, President Donald J. Trump issued his first executive order and it was directed at the Patient Protection and Affordable Care Act (ACA). The executive order formalized the Trump Administration’s policy to “seek the prompt repeal of the [“ACA”].” President Trump then directed executive department heads to “waive, defer, grant exemptions from, or delay the implementation of any provision or requirement” of the [ACA] that would impose a fiscal or regulatory burden
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Insurance Companies Narrowing Role in ACA Exchanges

In recent months, several major health insurance companies, including Aetna, Humana, and UnitedHealth Group, have announced their intention to reduce their footprints in the ACA healthcare exchanges. Aetna recently announced that it sustained a $200 million loss in the second-quarter of 2016 and over $430 million since January 2014 with respect to individual products. As a result, it “will reduce its individual public exchange participation from 778 to 242 counties for the 2017 plan year, maintaining an on-exchange presence in
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SCOTUS Orders Parties to Brief on Possible Compromise in ACA Case

On March 23, 2016, the U.S. Supreme Court heard oral arguments in Zubik, et al. v. Burwell, the case in which religious not-for-profits are challenging the process in which they can claim a religious exemption to the contraception requirement in the Affordable Care Act (ACA). On Tuesday, March 29, 2016, the court issued an unusual order hinting the court might be looking for some kind of compromise to deal with this highly controversial case. The court’s order requests supplemental briefing
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GAO’s Update on ACA Enrollment Process: CMS Encouraged to Take Steps to Monitor Program Cost, Risk, and Performance

The issue of fraud is still alive and well with respect to the health care exchanges established by the Affordable Care Act (ACA). The Government Accountability Office (GAO) recently issued a new update with respect to fraud in the federal exchanges. In that report, the GAO recommended that the Center for Medicaid and Medicare Services (CMS) strengthen enrollment controls and manage Fraud Risk. The report notes that implementation of the new eligibility and enrollment provisions for the first year was
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Supreme Court in Transition: What Happens to the ACA Case?

On Saturday, February 13, 2016, United States Supreme Court Justice Antonin Scalia, the longest serving justice on the Supreme Court, died in his sleep while on a hunting trip in Texas. One of the big questions now is what happens to the cases currently before the Court, especially those cases that were largely expected to be decided 5-4 while Justice Scalia was alive. Among those high profile cases is another one on the Affordable Care Act (ACA), Geneva College v.
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Recent Court Decisions Show Fight Over ACA is Alive and Well

The battle over the Affordable Care Act (ACA) is heating up again with two recent high-profile decisions. In the first case, the U.S. House of Representatives as an institution sued the executive branch over actions taken by the executive during the implementation of the ACA. This case is unique because it addresses the broader question of whether the legislative branch has the authority to sue the executive branch over how the executive implements statutes. In U.S. House of Representatives v.
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GAO Statement Highlights Deficiencies in Federal Exchange Enrollment Process

On July 16, 2015, the Government Accountability Office issued a written statement entitled “Patient Protection and Affordable Care Act: Observations of 18 Undercover Tests of Enrollment Controls for Health-Care Coverage and Consumer Subsidies Provided under the Act.” This statement contained the findings of “undercover testing of the [Exchange] application, enrollment, and eligibility verification controls using 18 fictitious identities” that GAO submitted or attempted to submit through the Exchange in several states in a variety of ways. Testing began in January
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Accommodations for Contraception Coverage Exemptions Replace Subsidies As The ACA Story of the Week

In recent months, the main event in the challenges against the Affordable Care Act centered on the subsidies provisions in the ACA. The Supreme Court decided this matter in King v. Burwell. In July 2015, there were two additional key developments related to the provision requiring employers to provide contraception coverage. On July 14, 2015, the 10th Circuit Court of Appeals in Little Sisters of the Poor Home v. Burwell held that the self-certifying procedure in place for religious not-for-profits
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Senate Panel to Probe Eligibility Verification Process for ACA Subsidies

The Senate’s Permanent Subcommittee on Investigations (PSI) has launched an inquiry into government subsidies under the Affordable Care Act available primarily in the form of advance premium tax credits. According to PSI’s letter to Secretary Burwell, the premium subsidies for last year were approximately $15 billion and are expected to reach $849 billion over the next ten years. Prompting the inquiry are concerns of improper over-payments with the goal of preventing government waste. According to the letter, “to ensure proper oversight,
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Californians – “Insurance on My Mind”

California voters had insurance on their minds during the mid-term elections with at least two insurance-related questions on the ballot. The first was Proposition 45, entitled the “Healthcare Insurance. Rate Changes. Initiative Statute.”  If approved, this initiative would have required the state’s Insurance Commissioner to approve any rate increases for individual and small group health insurance plans before those rate hikes took effect.  If the state’s Insurance Commissioner determined that a rate hike was unreasonable or excessive, the commissioner could
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